Fostering Sustainability in Teleradiology Medical Specialists Leading Change Mark Nevin Senior Executive Officer Member of HISA NSW Executive
Clinical Radiology Market Innovative, technology-based medical specialty Supports decision-making across medicine Mature digital standards – seamless information transfer across borders • 15% of overall Medicare expenditure • 25 million Medicare services • Over 2,100 clinical radiologists • Numerous other medical providers • 2,000 practices and hospitals Source: RANZCR 2017 data
Teleradiology Context Technology enabled image sharing and interpretation for over 20 years, replacing mail and courier ‘ teleradiology ’ Role of teleradiology • Radiologist workforce unevenly distributed • Referrers and consumers need 24/7/365 cover • Prompt access to results in busy departments Issues • Complex regulatory healthcare environment • Cumbersome payment rules, standards were inconsistent • Challenges in professional regulation
RANZCR Perspective Teleradiology is growing market (over 15 commercial providers in Australian and NZ markets). Market had evolved significantly, blurring traditional practice and teleradiology. Wider context of health policy reform and regulation (Medicare rules, Medical Council New Zealand, out of hours) Policies in place but prior standards and statements were not fit for purpose.
Taking the Lead Aim: convert policies into coherent and practicable standards What RANZCR did: • Market analysis – quantitative and qualitative • Understood model of service delivery • Reviewed international landscape • Established focused working group • Expertise from across industry
Teleradiology Standards Working Group Deconstructed prior position statements Converted policy to key principles Focused on key challenges: • Professional registration • Interaction between on-site and off-site • Communicating emergency findings • Clear lines of responsibility and protocols Aligned with RANZCR Standards of Practice, payment rules and guidelines
Examples of 14 Key Principles • An on-site clinical radiologist is the preferred model of service delivery - teleradiology is supplementary to comprehensive on- site clinical radiology. • Teleradiology must be carried out in a manner that is in the best interests of the patient and their medical care. • Image quality and image interpretation must not be compromised by the use of teleradiology reporting. • The reporting clinical radiologist must be registered and indemnified in the jurisdiction of image acquisition. • An adequate understanding of the language, cultural differences and specialist vocabulary of the jurisdiction is essential. • The clinical radiologist should be available for discussion as needed by the acquisition site or clinicians.
Teleradiology Defined “electronic transmission of diagnostic radiology images in digital form between locations (acquisition site to reporting site) for diagnosis and reporting by a clinical radiologist (or any other appropriately credentialed medical specialist) using a bi-directional data communication link that keeps all patient data secure”
Teleradiology Standards Draft produced and road tested by working group Member and stakeholder input over 6 months Core philosophy • Enable telehealth within safe parameters and clear professional supervision framework • Set information governance for service delivery • Clarify roles and responsibilities of all parties Published in December 2017 Incorporating to contracts, payment systems and standards
Wider Learnings Clinical radiology has extensive experience in telehealth – embrace change but establish clear parameters Learn from our approach to deliver scalable sustainable telehealth services
What’s Next for RANZCR? Advocate for implementation of teleradiology standards across health systems in Australia and New Zealand For clinical radiology, AI and machine learning technologies racing ahead, similar challenges lie therein Applying experience from teleradiology standards RANZCR is focusing on standards, ethics, market access, evolving skills for clinical radiologists and radiation oncologists
Summary Be proactive Focus on consumer journey Remember industry drivers and big picture Thank you mark.Nevin@ranzcr.edu.au
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